LOS ANGELES — California hospitals are struggling to meet a new, first-in-the-nation requirement that they have one nurse on duty for every five patients at all times, and officials say most institutions are falling short.

Some hospitals have tried to close the gap by hiring nurses from outside agencies and making staffers work more hours. Others are closing beds or keeping people longer in the emergency room to prevent other parts of the hospital from becoming overcrowded.

The new requirement comes amid a severe nationwide shortage of nurses.

“Even if money came down from heaven and paid for all of the extra costs, you still can’t find the nurses,” said Jan Emerson, a spokeswoman for the California Hospital Association.

Several states have minimum staffing levels for certain hospital wards, such as intensive care. California is the only state to establish mandatory levels in all areas, said Ken August, spokesman for the California Department of Health Services.

'These are people's lives here'The law, backed by California’s biggest nurses union and signed by then-Gov. Gray Davis in 1999, said hospitals must adhere to a staffing level set by the Department of Health Services. DHS then decided on a 1-to-6 ratio beginning in 2004 — a rule that took effect with similar difficulty — and 1-to-5 starting in January 2005.

Gov. Arnold Schwarzenegger tried to have the 1-to-5 requirement delayed for three years. But a judge ruled against him in March, and DHS notified the state’s nearly 400 public and private medical centers that they must immediately comply.

The 60,000-member California Nurses Association said the ratio will make hospitals safer.

Mary Bailey, a nurse in a diabetic ward at Long Beach Memorial Medical Center, said that years ago, some nurses had to handle 10 patients at a time.

“Those were the crying days — when it gets so overwhelming that you go home crying,” she said. “We’re not chopping broccoli. These are people’s lives here, and there’s nothing worse than going home and saying, ‘I didn’t pick up on that symptom.”’

But hospitals complain that it is virtually impossible to obey the law around the clock, when, say, a nurse takes a coffee break, or a ward is suddenly swamped with patients.

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John Wallace, a spokesman for the Los Angeles County Department of Health Services, said county hospitals are closing beds when necessary and spending millions to hire nurses from outside agencies.

At Methodist Hospital of Sacramento, more patients are being held in the ER — though not just because of the staffing new requirement, said Holly Worley, an emergency room nurse.

“There just aren’t enough RNs, period, and that was happening way before we had nursing ratios,” she said.

The nurses union has accused hospitals of exaggerating the difficulty in finding nurses. And Bailey said her hospital has had little trouble meeting the requirement, whether through overtime, reassigning of nurses to the overnight shift, or having a nurse take a paid “working lunch” in a room within earshot of her patients.

The state law carries no fines or other punishments for violating the new ratio. DHS can shut down a hospital that poses an immediate and serious threat to patient safety, but that is rare. One complaint has been filed, officials said last week.

Critics of the ratio argue that California’s hospitals need to find as many as 4,000 new nurses, at a cost in salary and benefits that Jim Lott of the Hospital Council of Southern California put at $400 million a year.